| NPI | 1457066318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC61563555) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA 61369720) |
| Enumeration Date | 2023-01-16 |
| Last Update Date | 2025-07-23 |