| NPI | 1104496108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61410527) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR R6779) |
| Enumeration Date | 2021-06-30 |
| Last Update Date | 2023-07-12 |