| NPI | 1568098853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MHC.LH.61363544) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR C11548) |
| Enumeration Date | 2020-03-18 |
| Last Update Date | 2026-04-17 |