| NPI | 1851798391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC60871642) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 101Y00000X Counselor | |
| Enumeration Date | 2014-11-27 |
| Last Update Date | 2025-03-20 |