| NPI | 1871775494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60959703) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 180.007858) |
| 101YM0800X Counselor, Mental Health (Licence: CA LPCC11238) | |
| Enumeration Date | 2007-12-05 |
| Last Update Date | 2024-10-24 |