NPI | 1154580009 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60331316) |
Additional Taxonomies | 133N00000X Nutritionist (Licence: WA NU60187446) |
Enumeration Date | 2008-06-05 |
Last Update Date | 2017-04-05 |