| NPI | 1710712013 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 104100000X Social Worker (Licence: WA SWIA.SC.70011605) | 
| Additional Taxonomies | 101Y00000X Counselor | 
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2024-09-05 | 
| Last Update Date | 2025-08-13 |