| NPI | 1649610106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CG60587686) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: ID LPC-5063) |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2018-11-08 |