| NPI | 1336747104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WA LH61420359) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH61420359) |
| 101Y00000X Counselor (Licence: WA LH61420359) | |
| Enumeration Date | 2020-10-14 |
| Last Update Date | 2023-10-19 |