| NPI | 1356785695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OR C4108) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA LH60630063) |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2025-04-18 |