| NPI | 1063818409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60514544) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR C3885) |
| Enumeration Date | 2014-11-12 |
| Last Update Date | 2025-01-23 |