| NPI | 1720414543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC60480555) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60414083) |
| 101YM0800X Counselor, Mental Health (Licence: WA CG60414083) | |
| Enumeration Date | 2013-09-25 |
| Last Update Date | 2014-11-23 |