| NPI | 1689111346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 10123) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH60918680) |
| Enumeration Date | 2017-01-19 |
| Last Update Date | 2025-02-19 |