| NPI | 1093366809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61308875) |
| Additional Taxonomies | 101Y00000X Counselor |
| 133NN1002X Nutritionist, Nutrition, Education (Licence: WA NU61087753) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-09-23 |
| Last Update Date | 2022-09-20 |