| NPI | 1518380179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60533629) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC60246483) |
| Enumeration Date | 2014-01-31 |
| Last Update Date | 2024-06-18 |