| NPI | 1265125868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: HI MHC-1206) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC61454072) |
| Enumeration Date | 2023-05-30 |
| Last Update Date | 2026-04-13 |