| NPI | 1457625949 |
|---|---|
| Former Name | FRED RAY MATHESON |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60525325) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2012-02-29 |
| Last Update Date | 2024-01-02 |