| NPI | 1437519246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LW60088002) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA LW60088002) |
| Enumeration Date | 2016-03-07 |
| Last Update Date | 2016-03-07 |