| NPI | 1265962435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 129753256004) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH60918637) |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2025-11-12 |