| NPI | 1558768747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC15069) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA WA61181852) |
| Enumeration Date | 2014-12-03 |
| Last Update Date | 2024-05-02 |