| NPI | 1063518223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA lw00006496) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA lw00006496) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2013-06-03 |