| NPI | 1245959543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CG61308832) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC61500767) |
| Enumeration Date | 2022-08-22 |
| Last Update Date | 2025-05-29 |