| NPI | 1154892362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC61341732) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60923211) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA CG60923211) | |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2023-11-01 |