| NPI | 1952189953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61665489) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 24402550) |
| Enumeration Date | 2023-09-20 |
| Last Update Date | 2025-07-15 |