| NPI | 1518992205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MHC.LH.61613822) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR C6738) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2026-09-06 |