| NPI | 1467925875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61160894) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR C6973) |
| Enumeration Date | 2019-01-08 |
| Last Update Date | 2023-08-02 |