| NPI | 1548799653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61263506) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC60751877) |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2024-07-09 |