| NPI | 1043788979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA SC60527379) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WA SC60527379) |
| Enumeration Date | 2018-11-08 |
| Last Update Date | 2018-12-19 |