| NPI | 1568703551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA SC60341239) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA SC60341239) |
| Enumeration Date | 2013-03-15 |
| Last Update Date | 2020-10-26 |