| NPI | 1083968887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60422602) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA CG60213129) |
| Enumeration Date | 2012-10-31 |
| Last Update Date | 2013-11-15 |