| NPI | 1235672957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60787398) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60209517) |
| Enumeration Date | 2016-11-29 |
| Last Update Date | 2020-02-17 |