| NPI | 1982766648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C5475) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH60851067) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2022-10-24 |