| NPI | 1134196504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH00011099) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA RC00049493) |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2018-12-28 |