| NPI | 1922467232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH60779138) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA MC60412225) |
| 101YP2500X Counselor Professional | |
| Enumeration Date | 2016-02-15 |
| Last Update Date | 2018-11-16 |