| NPI | 1972801454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH 00005657) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MN LP 4819) |
| Enumeration Date | 2011-03-07 |
| Last Update Date | 2011-03-07 |