| NPI | 1154645687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA SC61029875) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA CG60121781) |
| Enumeration Date | 2010-03-26 |
| Last Update Date | 2022-03-10 |