| NPI | 1033450804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60675744) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA CG60341621) |
| Enumeration Date | 2013-03-04 |
| Last Update Date | 2021-08-23 |