| NPI | 1205309697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH61188824) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60926562) |
| Enumeration Date | 2019-01-08 |
| Last Update Date | 2021-09-23 |