| NPI | 1396787784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH00005599) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: WA 351919F) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2007-07-08 |