| NPI | 1467893214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CG60397566) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA CG60397566) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA CO60318881) | |
| Enumeration Date | 2013-07-09 |
| Last Update Date | 2022-05-12 |