| NPI | 1750568689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C4578) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA RC00035986) |
| Enumeration Date | 2008-01-22 |
| Last Update Date | 2026-09-04 |