| NPI | 1912143744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH00003933) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA LF00001219) |
| Enumeration Date | 2008-12-29 |
| Last Update Date | 2008-12-29 |