| NPI | 1588867691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OR T0760) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA RC00047494) |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2023-05-17 |