| NPI | 1538377569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60536655) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA CG60113218) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2015-03-06 |