| NPI | 1922492412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60594258) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC60293363) |
| Enumeration Date | 2015-03-24 |
| Last Update Date | 2023-01-23 |