| NPI | 1649684846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60408975) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA CG60148019) |
| Enumeration Date | 2014-06-16 |
| Last Update Date | 2014-06-16 |