| NPI | 1245715978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH60740928) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: WA NU60573217) |
| Enumeration Date | 2018-09-27 |
| Last Update Date | 2018-09-27 |