| NPI | 1265741623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH60249067) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA MC60160760) |
| Enumeration Date | 2010-10-04 |
| Last Update Date | 2012-01-31 |