| NPI | 1043644008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60742238) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR C4098) |
| Enumeration Date | 2013-08-27 |
| Last Update Date | 2022-03-08 |