NPI | 1063496511 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH00008767) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WA LH00008767) |
Enumeration Date | 2005-11-29 |
Last Update Date | 2015-05-22 |