| NPI | 1346564515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WA LW60173056) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2010-03-17 |
| Last Update Date | 2018-01-10 |