| NPI | 1376815530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61543214) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC61383617) |
| Enumeration Date | 2012-02-03 |
| Last Update Date | 2024-05-29 |