| NPI | 1558541367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA RC00033455) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA RC00033455) |
| Enumeration Date | 2007-11-08 |
| Last Update Date | 2018-11-26 |