| NPI | 1649916164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC61618507) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 24-QMHA-R-5292) |
| Enumeration Date | 2022-05-08 |
| Last Update Date | 2024-12-16 |