| NPI | 1790979425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60522224) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 61716) |
| 101YM0800X Counselor, Mental Health | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2007-09-06 |
| Last Update Date | 2024-11-04 |