| NPI | 1215405790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA LW61373017) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60891838) |
| Enumeration Date | 2018-11-02 |
| Last Update Date | 2023-08-01 |