| NPI | 1104559038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA SC61619563) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG61320912) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-07-07 |
| Last Update Date | 2025-03-25 |