| 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 |