| NPI | 1366812174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC60597324) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH60738078) |
| Enumeration Date | 2015-10-06 |
| Last Update Date | 2017-02-24 |