| NPI | 1992114250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA 60926776) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701005886) |
| Enumeration Date | 2014-08-11 |
| Last Update Date | 2019-12-08 |