| NPI | 1164683736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60218652) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA RC00054785) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2024-02-02 |