| NPI | 1316334576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA CG60428605) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA CO60612040) |
| Enumeration Date | 2015-04-24 |
| Last Update Date | 2017-01-10 |