| NPI | 1063787216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60274245) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR C2814) |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2026-02-20 |