| NPI | 1902296528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60739452) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA 60293371) |
| Enumeration Date | 2015-02-03 |
| Last Update Date | 2022-07-21 |