| NPI | 1386047884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61031767) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OR THW00071) |
| Enumeration Date | 2014-09-29 |
| Last Update Date | 2024-01-17 |