| NPI | 1750795852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA CO60693284) |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2018-03-19 |