| NPI | 1831618057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60920602) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC60407020) |
| Enumeration Date | 2017-09-19 |
| Last Update Date | 2022-07-21 |