| NPI | 1144480708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH00010964) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR C2168) |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2011-06-14 |