| NPI | 1285189035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA SC61044965) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60683287) |
| 1041C0700X Social Worker, Clinical (Licence: WA CG60683287) | |
| Enumeration Date | 2016-08-22 |
| Last Update Date | 2021-07-07 |