| NPI | 1033881487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA SWIA.SC.70114655) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA SWIA.SC.70114655) |
| 106S00000X Behavior Technician | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-10-04 |
| Last Update Date | 2026-07-23 |