| NPI | 1346612850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61166834.) |
| Additional Taxonomies | 247200000X |
| 101Y00000X Counselor | |
| Enumeration Date | 2015-10-23 |
| Last Update Date | 2021-10-29 |