| NPI | 1467240879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA LW61363001) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2025-04-26 |
| Last Update Date | 2025-05-16 |