| NPI | 1013966589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH00005368) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR C1215) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2007-07-08 |