| NPI | 1770046526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA lw60893837) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA 60893837) |
| 101YM0800X Counselor, Mental Health (Licence: WA 60893837) | |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2019-04-09 |