| NPI | 1285886911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60238108) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WA RC00057081) |
| Enumeration Date | 2008-10-13 |
| Last Update Date | 2021-03-24 |