| NPI | 1083340285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61499324) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ME CC7450) |
| Enumeration Date | 2022-07-29 |
| Last Update Date | 2025-12-13 |