| NPI | 1932842903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH00009678) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MT BBH-LCPC-LIC-952) |
| Enumeration Date | 2022-04-18 |
| Last Update Date | 2022-04-18 |