| NPI | 1649647561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH-60986600) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: ID LCPC-9675) |
| 101YM0800X Counselor Mental Health (Licence: MS LPC-3198) | |
| 101YM0800X Counselor Mental Health (Licence: AZ LPC-22498) | |
| Enumeration Date | 2015-08-26 |
| Last Update Date | 2024-12-02 |