| NPI | 1033630512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61056175) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101Y00000X Counselor (Licence: WA MC60894403) | |
| Enumeration Date | 2017-07-05 |
| Last Update Date | 2025-02-28 |