| NPI | 1467528794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OR C1157) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA LH00006800) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2013-05-13 |