| NPI | 1912386129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA LMHC5000025) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH60823771) |
| Enumeration Date | 2015-05-20 |
| Last Update Date | 2025-01-10 |