| NPI | 1770274482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR R9219) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA 61660503) |
| Enumeration Date | 2023-05-15 |
| Last Update Date | 2025-04-08 |