| NPI | 1649606401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TX LPC74495) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA MC60364080) |
| 101YM0800X Counselor, Mental Health (Licence: WA MC60364080) | |
| Enumeration Date | 2013-09-24 |
| Last Update Date | 2015-11-26 |