| NPI | 1356749071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60783927) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2014-12-11 |
| Last Update Date | 2021-07-02 |