| NPI | 1710429923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH60921208) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA MC 60673296) |
| Enumeration Date | 2016-11-07 |
| Last Update Date | 2023-06-19 |