| NPI | 1134654353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA 60739702) |
| Enumeration Date | 2017-04-25 |
| Last Update Date | 2017-06-19 |