| NPI | 1831546084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 87633) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH60972124) |
| 101YM0800X Counselor, Mental Health (Licence: WA CG60672022) | |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2021-12-28 |