| NPI | 1821413055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61248633) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CO LPC.0012765) |
| Enumeration Date | 2014-02-25 |
| Last Update Date | 2024-10-07 |