| NPI | 1275212425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA CG1438535) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA CG1438535) |
| Enumeration Date | 2023-07-14 |
| Last Update Date | 2023-07-14 |