| NPI | 1346545910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60490510) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MG60128082) |
| Enumeration Date | 2011-01-12 |
| Last Update Date | 2021-02-10 |