| NPI | 1366825283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60823154) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TN 3129) |
| Enumeration Date | 2015-07-09 |
| Last Update Date | 2023-01-19 |