| NPI | 1134275225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA 3455) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA 50391) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2011-02-15 |