| NPI | 1952050510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61556737) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA MC61439464) |
| 101YM0800X Counselor, Mental Health (Licence: WA CG61255547) | |
| Enumeration Date | 2022-03-21 |
| Last Update Date | 2024-07-31 |