| NPI | 1720733397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA LH61472612) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPCC.0019187) |
| Enumeration Date | 2022-02-13 |
| Last Update Date | 2024-01-23 |