| NPI | 1629519616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61357443) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60742843) |
| 101YM0800X Counselor, Mental Health | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA CG60742843) | |
| 104100000X Social Worker | |
| Enumeration Date | 2017-03-10 |
| Last Update Date | 2023-02-22 |