| NPI | 1942500624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH60772233) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: OR C7972) |
| Enumeration Date | 2010-10-27 |
| Last Update Date | 2024-03-13 |