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 |