| NPI | 1669823589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA CG60673709) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2024-11-21 |