NPI | 1407323140 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61383324) |
Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60813382) |
Enumeration Date | 2018-10-31 |
Last Update Date | 2024-03-26 |