| NPI | 1679759500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LCPC-6701) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH60249089) |
| Enumeration Date | 2008-01-10 |
| Last Update Date | 2018-10-25 |