| NPI | 1538226444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH60116269) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA LH60116269) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2014-03-07 |