| NPI | 1902919384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH00010833) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR C2063) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2018-10-26 |