| NPI | 1972055366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60914094) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC60602145) |
| Enumeration Date | 2016-11-01 |
| Last Update Date | 2022-07-21 |