| NPI | 1245601632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60804727) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OR C5115) |
| Enumeration Date | 2015-10-12 |
| Last Update Date | 2025-04-02 |