| NPI | 1407632573 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA SC61506928) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG61442633) |
| 1041C0700X Social Worker Clinical | |
| Enumeration Date | 2023-09-05 |
| Last Update Date | 2024-07-09 |