| NPI | 1306305297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA 61393808) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA MC60923333) |
| 101YM0800X Counselor, Mental Health (Licence: WA MC60923333) | |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2024-11-13 |