| NPI | 1508102880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA MC60580779) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60321227) |
| Enumeration Date | 2012-12-14 |
| Last Update Date | 2024-07-23 |