| NPI | 1033574546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CG61249724) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 171M00000X Case Manager/Care Coordinator | |
| 101Y00000X Counselor | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-12-28 |
| Last Update Date | 2022-05-03 |