| NPI | 1356951388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH60992581) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA MC610484) |
| 101YS0200X Counselor School (Licence: WA 565032J) | |
| Enumeration Date | 2020-08-04 |
| Last Update Date | 2023-09-18 |