| NPI | 1265742506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA LH61531141) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC60915228) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-10-20 |
| Last Update Date | 2025-08-07 |