| NPI | 1093526980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC61622237) |
| Additional Taxonomies | 101YS0200X Counselor, School |
| Enumeration Date | 2025-01-18 |
| Last Update Date | 2025-01-18 |