| NPI | 1225759772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC61510545) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR R8846) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-09-02 |
| Last Update Date | 2025-03-17 |