| NPI | 1538311410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60366681) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA RC00058614) |
| 101YM0800X Counselor, Mental Health (Licence: WA SC60113117) | |
| Enumeration Date | 2008-10-22 |
| Last Update Date | 2022-12-28 |