| NPI | 1932933199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MHCA.MC.70054750) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CAAR.CG.61604401) |
| Enumeration Date | 2024-08-29 |
| Last Update Date | 2026-07-28 |