| NPI | 1912326240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA 60507966) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60461023) |
| 101Y00000X Counselor | |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2021-02-01 |