| NPI | 1841396199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH5347) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR 1203) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2013-03-01 |