| NPI | 1144373283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WA RC00052893) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID LCSW29916) |
| Enumeration Date | 2007-01-20 |
| Last Update Date | 2009-08-05 |