| NPI | 1801151824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-2062) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH 60185615) |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2012-07-05 |