| NPI | 1124289269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61093909) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA SC60706318) |
| 104100000X Social Worker (Licence: WA LW61093909) | |
| 104100000X Social Worker (Licence: WA SC60706318) | |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2025-06-08 |