| NPI | 1831756238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA MC60945630) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA LH61262920) |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2023-04-12 |