| NPI | 1356415293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA CG60764058) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA RC00048151) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2023-11-10 |