| NPI | 1225379761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH00006352) |
| Enumeration Date | 2013-03-07 |
| Last Update Date | 2015-12-11 |