| NPI | 1215558796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC61244016) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2020-05-06 |
| Last Update Date | 2023-07-12 |