| NPI | 1245760313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA SC60774690) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 1041C0700X Social Worker, Clinical (Licence: ID LCSW-40920) | |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2023-02-06 |