| NPI | 1023415544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C6913) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MHC.LH.70068189) |
| Enumeration Date | 2014-11-26 |
| Last Update Date | 2026-04-07 |