| NPI | 1710613476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61666657) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC61322136) |
| Enumeration Date | 2022-07-26 |
| Last Update Date | 2025-04-28 |