| NPI | 1578975900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61188723) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM T-0162991) |
| Enumeration Date | 2014-05-20 |
| Last Update Date | 2024-05-28 |