| NPI | 1558761080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WA LH60953703) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA CG60230122) |
| Enumeration Date | 2014-09-03 |
| Last Update Date | 2026-01-02 |