| NPI | 1255898441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA 61195059) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA 0000) |
| Enumeration Date | 2019-02-25 |
| Last Update Date | 2021-08-20 |