| NPI | 1437819539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA SC61501660) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 101Y00000X Counselor (Licence: WA CG61243243) | |
| Enumeration Date | 2021-12-30 |
| Last Update Date | 2024-02-10 |