| NPI | 1659671469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61470468) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA 60153970) |
| Enumeration Date | 2010-10-26 |
| Last Update Date | 2023-12-19 |