| NPI | 1992059711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH00003819) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH00003814) |
| Enumeration Date | 2012-10-31 |
| Last Update Date | 2020-04-29 |