| NPI | 1437718475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MHCA.MC.61451386) |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2026-03-03 |