| NPI | 1407251408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C3550) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH60497951) |
| 101YP2500X Counselor, Professional (Licence: MO 2012024654) | |
| Enumeration Date | 2014-11-03 |
| Last Update Date | 2016-02-04 |