| NPI | 1598386021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61254033) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health (Licence: WA MC61085665) | |
| Enumeration Date | 2020-05-06 |
| Last Update Date | 2023-01-23 |