| NPI | 1154749885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA lw60560942) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA CG60740446) |
| 103TC1900X Psychologist, Counseling (Licence: WA LH60604130) | |
| 1041C0700X Social Worker, Clinical (Licence: WA SC60340940) | |
| 1041C0700X Social Worker, Clinical (Licence: WA LW60560942) | |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2025-01-03 |