| NPI | 1508968637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60498114) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR C5984) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2024-01-03 |