| NPI | 1689567042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MHCA.MC.70036888) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR R12274) |
| Enumeration Date | 2025-06-02 |
| Last Update Date | 2025-11-10 |