| NPI | 1164990016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA LW61169502) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WA CG60146031) |
| Enumeration Date | 2018-11-08 |
| Last Update Date | 2022-02-04 |