| NPI | 1134973225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC61538440) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: WA MC61538440) |
| Enumeration Date | 2024-04-15 |
| Last Update Date | 2026-05-15 |