| NPI | 1497222582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA CG60533953) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA CG60533953) |
| Enumeration Date | 2018-10-27 |
| Last Update Date | 2019-09-26 |