| NPI | 1508217290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA SWIA.SC.60941265) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA SWIA.SC.60941265) |
| Enumeration Date | 2016-06-24 |
| Last Update Date | 2026-03-18 |