| NPI | 1013671213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MHC.LH.61463109) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OK LPC12386) |
| Enumeration Date | 2021-10-25 |
| Last Update Date | 2026-07-02 |