| NPI | 1437989829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61642358) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC61516406) |
| Enumeration Date | 2024-08-01 |
| Last Update Date | 2025-02-13 |