| NPI | 1043603855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60707671) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LPC-5803) |
| Enumeration Date | 2015-03-18 |
| Last Update Date | 2021-01-14 |