| NPI | 1073864914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C10984) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MHC.LH.60461689) |
| Enumeration Date | 2012-10-01 |
| Last Update Date | 2026-05-29 |