| NPI | 1013339027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60815345) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WA LW60815345) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP60552548) | |
| Enumeration Date | 2014-01-09 |
| Last Update Date | 2020-09-01 |