NPI | 1104409531 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61554033) |
Additional Taxonomies | 101Y00000X Counselor (Licence: WA MC61337329) |
Enumeration Date | 2021-05-03 |
Last Update Date | 2025-01-27 |