| NPI | 1851766976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61136624) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID 5671) |
| Enumeration Date | 2015-12-01 |
| Last Update Date | 2025-02-21 |