| NPI | 1598243008 |
|---|---|
| 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 LH60691241) |
| Enumeration Date | 2018-08-06 |
| Last Update Date | 2019-09-17 |