| NPI | 1518276591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60171115) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC60180619) |
| Enumeration Date | 2010-09-24 |
| Last Update Date | 2023-07-27 |