| NPI | 1679765333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C1198) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH00004271) |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2011-05-18 |