| NPI | 1740657980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA CG 60642539) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA CO 60604805) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-08-24 |
| Last Update Date | 2019-03-06 |