| NPI | 1871899385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA CG60238865) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60238865) |
| Enumeration Date | 2011-01-31 |
| Last Update Date | 2014-08-12 |