| NPI | 1063755643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH61406913) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2023-05-08 |