| NPI | 1518410430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA 60827194) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60677305) |
| Enumeration Date | 2016-07-27 |
| Last Update Date | 2020-12-02 |