| NPI | 1649515248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61194404) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60869366) |
| Enumeration Date | 2012-12-07 |
| Last Update Date | 2022-07-11 |