| NPI | 1245582451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60247155) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA LW60247155) |
| Enumeration Date | 2012-10-11 |
| Last Update Date | 2016-12-04 |