| NPI | 1568983997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60869790) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC60761069) |
| Enumeration Date | 2017-07-06 |
| Last Update Date | 2018-08-15 |