| NPI | 1871985663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA 60967468) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC 60433945) |
| Enumeration Date | 2015-03-03 |
| Last Update Date | 2022-04-14 |