| NPI | 1841664471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH60810335) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA SC60489162) |
| Enumeration Date | 2015-11-19 |
| Last Update Date | 2022-07-06 |