| NPI | 1831846708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH61543155) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG61260750) |
| Enumeration Date | 2022-03-09 |
| Last Update Date | 2024-04-26 |