| NPI | 1750568325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60108045) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 006385) |
| Enumeration Date | 2008-01-26 |
| Last Update Date | 2017-01-16 |