| NPI | 1922681238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61249806) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: DC PRC15512) |
| Enumeration Date | 2021-05-04 |
| Last Update Date | 2022-03-16 |