| NPI | 1104225598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA FC00000024) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA LW00005417) |
| Enumeration Date | 2014-08-21 |
| Last Update Date | 2014-08-21 |