| NPI | 1548986961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61484512) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC61276484) |
| Enumeration Date | 2022-10-17 |
| Last Update Date | 2026-09-18 |