| NPI | 1750687521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH60112655) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: WA LH60112655) |
| 101YM0800X Counselor Mental Health (Licence: CT 2481) | |
| 101Y00000X Counselor (Licence: CT 2481) | |
| 101YP2500X Counselor Professional (Licence: CT 2481) | |
| 101Y00000X Counselor (Licence: WA LH60112655) | |
| Enumeration Date | 2011-01-26 |
| Last Update Date | 2014-01-31 |