| NPI | 1811269772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60090934) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA HP60090870) |
| Enumeration Date | 2012-02-07 |
| Last Update Date | 2012-02-07 |