| NPI | 1972762490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C1132) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA 61606543) |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2025-07-11 |