| 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 |