| NPI | 1568005130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LC11328) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH61159709) |
| Enumeration Date | 2019-10-25 |
| Last Update Date | 2025-07-28 |