| NPI | 1790350130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA MC61426504) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA CG61177484) |
| Enumeration Date | 2021-05-26 |
| Last Update Date | 2023-07-06 |