| NPI | 1447065818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA MC61617880) |
| Additional Taxonomies | 101YS0200X Counselor School (Licence: WA 613418C) |
| Enumeration Date | 2025-02-11 |
| Last Update Date | 2025-02-11 |