| NPI | 1366206476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA 1366206476) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2024-02-08 |
| Last Update Date | 2024-07-22 |