| NPI | 1225604077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC61434022) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA MC61434022) |
| Enumeration Date | 2021-06-02 |
| Last Update Date | 2023-07-10 |