| NPI | 1427169804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LF00001236) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR T0358) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2022-01-19 |