| NPI | 1851769202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-21084) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP60682694) | |
| 101YM0800X Counselor, Mental Health (Licence: WA MC 60675660) | |
| Enumeration Date | 2015-09-02 |
| Last Update Date | 2024-05-29 |