| NPI | 1942670666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60504010) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LC5781) |
| Enumeration Date | 2015-10-07 |
| Last Update Date | 2015-10-07 |