| NPI | 1902603269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61655925) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR C10924) |
| Enumeration Date | 2025-02-25 |
| Last Update Date | 2026-08-07 |