| NPI | 1144798026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61020431) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60859064) |
| Enumeration Date | 2018-11-08 |
| Last Update Date | 2019-12-30 |