NPI | 1780093385 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60840558) |
Additional Taxonomies | 101Y00000X Counselor (Licence: WA MC60463521) |
Enumeration Date | 2014-08-07 |
Last Update Date | 2020-04-29 |