| NPI | 1992943385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: ID 6366) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA 60022726) |
| Enumeration Date | 2009-01-23 |
| Last Update Date | 2021-06-10 |