| NPI | 1295416634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC61543449) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA CG61440908) |
| Enumeration Date | 2023-07-28 |
| Last Update Date | 2025-08-05 |