| NPI | 1881894798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH000090982) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH00009082) |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2014-03-31 |