| NPI | 1104281385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA LH61445884) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH61445884) |
| Enumeration Date | 2015-12-15 |
| Last Update Date | 2025-08-07 |