| NPI | 1376859421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60237239) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA LPC012344) |
| 101YM0800X Counselor, Mental Health (Licence: VA 0701010529) | |
| 101YM0800X Counselor, Mental Health (Licence: OR C6609) | |
| Enumeration Date | 2010-08-26 |
| Last Update Date | 2024-01-23 |