| NPI | 1386479178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC61635058) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 17321) |
| 101YM0800X Counselor, Mental Health (Licence: CA 17321) | |
| Enumeration Date | 2024-09-03 |
| Last Update Date | 2025-10-01 |