| NPI | 1871808238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: ID LCPC7962) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH60139101) |
| Enumeration Date | 2010-08-10 |
| Last Update Date | 2021-06-25 |