| NPI | 1841977691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC61353158) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA MC61353158) |
| Enumeration Date | 2023-07-03 |
| Last Update Date | 2023-07-11 |