| NPI | 1689971236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WA LH60116271) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH60116271) |
| 225800000X Recreation Therapist (Licence: WA RE60048743) | |
| Enumeration Date | 2011-02-17 |
| Last Update Date | 2020-11-04 |