| NPI | 1972098002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61319662) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC60418963) |
| Enumeration Date | 2018-07-01 |
| Last Update Date | 2023-05-31 |