| NPI | 1225507502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61149830) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60877134) |
| Enumeration Date | 2018-11-16 |
| Last Update Date | 2022-04-14 |