| NPI | 1255972063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60869619) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA LW60869619) |
| 106H00000X Marriage & Family Therapist (Licence: WA LW60869619) | |
| 101YM0800X Counselor, Mental Health (Licence: WA LW60869619) | |
| Enumeration Date | 2019-10-02 |
| Last Update Date | 2025-10-29 |