| NPI | 1750969630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH61505610) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA MC61047481) |
| Enumeration Date | 2021-03-31 |
| Last Update Date | 2024-06-03 |