| NPI | 1649692948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID LCPC-7348) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH-60640951) |
| Enumeration Date | 2014-01-07 |
| Last Update Date | 2022-05-06 |