| NPI | 1306289905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61468090) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA CG60225687) |
| Enumeration Date | 2013-04-12 |
| Last Update Date | 2023-11-14 |