| NPI | 1962704890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA CG60458966) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NE 9283) |
| Enumeration Date | 2010-11-29 |
| Last Update Date | 2020-12-16 |