| NPI | 1417345109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C4747) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH60756275) |
| Enumeration Date | 2015-01-03 |
| Last Update Date | 2023-10-17 |