| NPI | 1114282803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60598947) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC 60281458) |
| Enumeration Date | 2012-07-09 |
| Last Update Date | 2025-11-21 |