| NPI | 1164906137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA SC61098366) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA SA61078808) |
| Enumeration Date | 2018-09-17 |
| Last Update Date | 2020-09-09 |