| NPI | 1528574647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA 60826827) |
| 101YP2500X Counselor, Professional (Licence: OR C5994) | |
| Enumeration Date | 2017-12-27 |
| Last Update Date | 2021-01-13 |