| NPI | 1497026355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA MC60319918) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA MC60319918) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA CO60344511) | |
| Enumeration Date | 2012-01-24 |
| Last Update Date | 2013-09-19 |