| NPI | 1629553961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA MC60737376) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA CG60164334) |
| Enumeration Date | 2018-10-02 |
| Last Update Date | 2025-01-08 |