| NPI | 1497894653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-12366) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH00011018) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2018-06-16 |