| NPI | 1023345105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA CO60508447) |
| Enumeration Date | 2009-11-10 |
| Last Update Date | 2017-03-08 |