| NPI | 1356887905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C6405) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH60868571) |
| 101YM0800X Counselor, Mental Health (Licence: WA CG60539097) | |
| Enumeration Date | 2017-01-06 |
| Last Update Date | 2024-10-07 |