| NPI | 1033671516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 1041C0700X Social Worker, Clinical (Licence: WA sc61678605) | |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2026-01-19 |