| NPI | 1174908321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C3611) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WA LH60618681) |
| Enumeration Date | 2015-07-29 |
| Last Update Date | 2016-09-02 |