| NPI | 1285188169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60866573) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MN 3946) |
| Enumeration Date | 2016-08-09 |
| Last Update Date | 2026-03-26 |