| NPI | 1518559517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH91331932) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA LW61549296) |
| Enumeration Date | 2021-02-10 |
| Last Update Date | 2024-12-20 |