| NPI | 1336951326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA CL61646402) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CL61646402) |
| Enumeration Date | 2025-01-25 |
| Last Update Date | 2025-01-25 |