| NPI | 1861541765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60090293) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WA RC00051199) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2009-05-14 |