| NPI | 1538223227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH 60224988) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: IL 180-005531) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2020-09-30 |