| NPI | 1316219850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA SC 6060177968) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA SC 60177968) |
| Enumeration Date | 2012-01-30 |
| Last Update Date | 2012-01-30 |