| NPI | 1669035630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA SC61510670) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CL61419843) |
| 101Y00000X Counselor (Licence: WA CG60940639) | |
| Enumeration Date | 2019-04-16 |
| Last Update Date | 2024-04-29 |