| NPI | 1215483821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60717495) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA SC60137902) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2020-01-07 |