| NPI | 1346960606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61653862) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC61467157) |
| Enumeration Date | 2022-08-29 |
| Last Update Date | 2025-03-19 |