| NPI | 1124850383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC61665413) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 94726) |
| Enumeration Date | 2024-08-16 |
| Last Update Date | 2025-06-27 |