| NPI | 1699073783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA CG60271241) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YP2500X Counselor, Professional (Licence: OR C4816) | |
| Enumeration Date | 2011-03-14 |
| Last Update Date | 2018-06-12 |