| NPI | 1558036202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WA SC61358710) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2021-08-14 |
| Last Update Date | 2025-03-26 |