| NPI | 1558834192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA SC61546413) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60960707) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA CG60960707) | |
| Enumeration Date | 2019-01-07 |
| Last Update Date | 2024-09-16 |