| NPI | 1649923905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID 8331429) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR C9345) |
| 101YM0800X Counselor, Mental Health (Licence: WA LH61671194) | |
| Enumeration Date | 2022-01-27 |
| Last Update Date | 2026-02-25 |