| NPI | 1023760535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA MC61389666) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2022-01-25 |
| Last Update Date | 2024-01-02 |