| NPI | 1003288796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA LW61234841) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60648868) |
| 104100000X Social Worker (Licence: WA SC61158375) | |
| 1041C0700X Social Worker, Clinical (Licence: WA LW61234841) | |
| Enumeration Date | 2015-10-21 |
| Last Update Date | 2022-04-22 |