| NPI | 1629574090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA 60822202) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 6489) |
| 101YM0800X Counselor, Mental Health (Licence: LA 1291) | |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2019-06-11 |