| NPI | 1346533817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA SC60236257) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA SC60236257) |
| Enumeration Date | 2011-05-17 |
| Last Update Date | 2025-06-16 |