| NPI | 1508583626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR R6908) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC61180264) |
| Enumeration Date | 2022-10-20 |
| Last Update Date | 2022-11-07 |