| NPI | 1528804085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA SC61578550) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA SC61578550) |
| Enumeration Date | 2024-07-03 |
| Last Update Date | 2024-07-10 |