| NPI | 1114445178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA 101YM0800X) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 104100000X Social Worker | |
| Enumeration Date | 2017-08-30 |
| Last Update Date | 2019-02-28 |