| NPI | 1093261042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA SC60850070) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA SC60850070) |
| Enumeration Date | 2016-08-30 |
| Last Update Date | 2024-07-23 |