| NPI | 1891986899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 319731-6004) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MHC.LH.70018425) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2026-06-29 |