| NPI | 1841608270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: LH60943226) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA 60469381) |
| Enumeration Date | 2014-07-29 |
| Last Update Date | 2020-02-10 |