| NPI | 1366328510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA 00007911) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MT 81250) |
| Enumeration Date | 2025-08-13 |
| Last Update Date | 2025-08-26 |