| NPI | 1043785595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WA LW61136122) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60910097) |
| Enumeration Date | 2018-10-11 |
| Last Update Date | 2021-06-14 |