| NPI | 1275917338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA 60645976) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA 60505492) |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2017-05-04 |