| NPI | 1558845636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC60896168) |
| Enumeration Date | 2018-09-24 |
| Last Update Date | 2023-09-18 |