| NPI | 1528494010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60640859) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA 60486816) |
| Enumeration Date | 2013-09-17 |
| Last Update Date | 2016-03-21 |