| NPI | 1487954699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60258551) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60128398) |
| Enumeration Date | 2010-10-22 |
| Last Update Date | 2014-07-23 |