| NPI | 1215566443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC61231464) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG61219096) |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2023-12-11 |