| NPI | 1356646046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60620675) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC60189409) |
| 101YM0800X Counselor, Mental Health (Licence: WA CG60434410) | |
| Enumeration Date | 2011-01-11 |
| Last Update Date | 2016-02-04 |