| NPI | 1396406500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA SC70020752) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG61268289) |
| Enumeration Date | 2022-01-10 |
| Last Update Date | 2025-10-23 |