| NPI | 1932279890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VT 068.0076445) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA RC00047624) |
| 101YM0800X Counselor, Mental Health (Licence: WA LH00011059) | |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2018-05-21 |