| NPI | 1497218572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61182148) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA 60932956) |
| Enumeration Date | 2019-04-07 |
| Last Update Date | 2021-08-18 |