| NPI | 1881208122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61384352) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60808070) |
| 101YM0800X Counselor, Mental Health (Licence: WA MC61100805) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-09-03 |
| Last Update Date | 2023-04-19 |