| NPI | 1396901757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AK 713) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA RC60018183) |
| 101YM0800X Counselor, Mental Health (Licence: WA LH60210091) | |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2012-12-20 |