| NPI | 1699868232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA RC00055358) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH998691770) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2012-08-27 |