| NPI | 1881253185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA MC60893201) |
| Additional Taxonomies | 101YP1600X Counselor Pastoral |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2020-05-09 |