| NPI | 1174111843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH12010) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH61629335) |
| Enumeration Date | 2021-01-07 |
| Last Update Date | 2025-03-10 |