| NPI | 1073382370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA SC61669282) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CG61514693) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-12-28 |
| Last Update Date | 2025-08-22 |