| NPI | 1629591078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C6103) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH61001122) |
| Enumeration Date | 2017-07-18 |
| Last Update Date | 2024-06-04 |