NPI | 1972063063 |
---|---|
Former Name | MICHAEL STEVEN BUAKNECHT |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA CU61643874) |
Additional Taxonomies | 101Y00000X Counselor (Licence: WA 60942160) |
101YM0800X Counselor, Mental Health | |
Enumeration Date | 2019-03-23 |
Last Update Date | 2025-02-11 |