| NPI | 1700495488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA SC61331643) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG61085743) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-07-28 |
| Last Update Date | 2022-09-15 |