| NPI | 1235796483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH00009050) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA 00009050) |
| Enumeration Date | 2019-05-23 |
| Last Update Date | 2019-05-23 |