| NPI | 1912447368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60875123) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA MC60402674) |
| Enumeration Date | 2017-03-05 |
| Last Update Date | 2019-04-15 |