| NPI | 1255939278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA CG61114074) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: WA SC61124149) |
| Enumeration Date | 2020-10-12 |
| Last Update Date | 2023-02-02 |