| NPI | 1093523946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MHCA.MC.70131529) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CAAR.CG.61640418) |
| Enumeration Date | 2024-12-24 |
| Last Update Date | 2026-07-30 |