| NPI | 1881750966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA 61362640) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60587297) |
| Enumeration Date | 2006-12-31 |
| Last Update Date | 2022-11-22 |