| NPI | 1689448052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61658479) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA SC61364725) |
| Enumeration Date | 2023-11-07 |
| Last Update Date | 2026-06-10 |