| NPI | 1831560226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61261181) |
| Additional Taxonomies | 372600000X Adult Companion |
| Enumeration Date | 2015-10-12 |
| Last Update Date | 2022-06-14 |