| NPI | 1619336351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OR C7806) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WI 8627-125) |
| 101YM0800X Counselor Mental Health (Licence: WA LH60807062) | |
| Enumeration Date | 2016-02-22 |
| Last Update Date | 2023-12-28 |