| NPI | 1285496380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC61634219) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: MS P-1045) |
| Enumeration Date | 2024-01-25 |
| Last Update Date | 2025-02-26 |