| NPI | 1588126841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CG60953128) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA CG60953128) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA CG60953128) | |
| Enumeration Date | 2019-04-04 |
| Last Update Date | 2022-10-13 |