| NPI | 1396114070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA 61246667) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA 61092783) |
| Enumeration Date | 2015-09-23 |
| Last Update Date | 2022-04-13 |