| NPI | 1437541711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60336413) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MT 37070) |
| Enumeration Date | 2015-02-24 |
| Last Update Date | 2022-12-30 |