| NPI | 1619283116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MT LCPC-LIC-62380) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH60099914) |
| Enumeration Date | 2010-08-23 |
| Last Update Date | 2024-06-21 |