| NPI | 1134211428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW00005282) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH00004175) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2025-09-11 |