| NPI | 1699330076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61168984) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CT 3741) |
| Enumeration Date | 2019-05-01 |
| Last Update Date | 2021-07-19 |