| NPI | 1639117880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR R11000) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC61660610) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2026-07-10 |