| NPI | 1659108199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA CDPT.CO.60883214) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MHCA.MC.70020486) |
| Enumeration Date | 2024-09-18 |
| Last Update Date | 2026-08-20 |