| NPI | 1598248973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LMSW-43027) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA CG60882583) |
| Enumeration Date | 2018-09-11 |
| Last Update Date | 2024-01-16 |