| NPI | 1447079439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC61620781) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TX 105343) |
| Enumeration Date | 2024-10-07 |
| Last Update Date | 2025-01-06 |