| NPI | 1275775793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60678050) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC007634) |
| Enumeration Date | 2009-03-30 |
| Last Update Date | 2021-12-13 |