| NPI | 1245535376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CG60169219) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA CG.60169219) |
| Enumeration Date | 2011-01-20 |
| Last Update Date | 2021-05-20 |