| NPI | 1497411086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA SC60309236) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA CG60294779) |
| Enumeration Date | 2021-11-09 |
| Last Update Date | 2022-07-20 |