| NPI | 1255456935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH00010865) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA RC00049167) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2019-02-20 |