| NPI | 1477027092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61097429) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC60887647) |
| Enumeration Date | 2019-01-16 |
| Last Update Date | 2023-03-07 |