| NPI | 1518011931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH-3931) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA FC-192) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2007-07-08 |