| NPI | 1154573111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60198099) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WA RC60045670) |
| Enumeration Date | 2008-10-21 |
| Last Update Date | 2021-09-01 |