| NPI | 1417793837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MHC.LH.61684577) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TN 6490) |
| Enumeration Date | 2024-07-04 |
| Last Update Date | 2026-02-10 |