| NPI | 1942386016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH00005993) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR C1332) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2012-03-09 |