| NPI | 1477018562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA SC60902329) |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical (Licence: WA SC60902329) | |
| Enumeration Date | 2019-02-04 |
| Last Update Date | 2021-02-17 |