| NPI | 1902373012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61176387) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC60882488) |
| Enumeration Date | 2018-10-26 |
| Last Update Date | 2021-07-16 |