| 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 |