| NPI | 1881737922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA 00005989) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health (Licence: WA LH00005989) | |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2019-02-05 |