| NPI | 1487239216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61538818) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701010288) |
| 101YP2500X Counselor, Professional (Licence: VA 0701010288) | |
| Enumeration Date | 2021-03-12 |
| Last Update Date | 2024-10-30 |