| NPI | 1336486778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60406535) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC 60230157) |
| Enumeration Date | 2013-01-04 |
| Last Update Date | 2020-04-05 |