| NPI | 1982180667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: LH60998160) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH60998160) |
| Enumeration Date | 2018-07-16 |
| Last Update Date | 2022-04-19 |