| NPI | 1093118986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH 60710181) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA CO60515493) |
| Enumeration Date | 2014-10-06 |
| Last Update Date | 2017-01-03 |