| NPI | 1568842532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60967738) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC60478443) |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2019-08-05 |