| NPI | 1629268784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: WA LH60550815) |
| Additional Taxonomies | 222Q00000X Developmental Therapist (Licence: WA 1-06-2882) |
| 101YM0800X Counselor Mental Health (Licence: WA LH60550815) | |
| 101Y00000X Counselor (Licence: WA CG60334843) | |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2023-04-14 |