| NPI | 1013485564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09928271) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 104100000X Social Worker (Licence: WA LW61225836) | |
| Enumeration Date | 2018-11-02 |
| Last Update Date | 2023-04-19 |