| NPI | 1548735707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61071652) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC60894074) |
| Enumeration Date | 2018-10-03 |
| Last Update Date | 2024-05-10 |