| NPI | 1790055671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH60387411) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: WA LH 60387411) |
| Enumeration Date | 2012-01-09 |
| Last Update Date | 2024-09-10 |