| NPI | 1205998598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA LW60593518) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60135547) |
| 101YM0800X Counselor Mental Health (Licence: WA CG60135547) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA CO60241395) | |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2016-02-26 |