| NPI | 1952774671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60814871) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WA MC60472290) |
| Enumeration Date | 2015-11-03 |
| Last Update Date | 2020-08-19 |