| NPI | 1760629695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60258116) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA RC00044315) |
| Enumeration Date | 2009-01-14 |
| Last Update Date | 2023-06-20 |