| NPI | 1427699644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA MC61082897) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-09-30 |
| Last Update Date | 2020-10-20 |