| NPI | 1760614937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH60269994) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA LH60269994) |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2014-07-22 |