| NPI | 1811771090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA MC61524093) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: FL IMH24492) |
| Enumeration Date | 2023-08-21 |
| Last Update Date | 2024-06-18 |