| NPI | 1093742595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60063586) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA RC00054597) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2026-05-04 |