| NPI | 1366078644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA 61247193) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA 61015885) |
| Enumeration Date | 2020-03-18 |
| Last Update Date | 2022-06-15 |