| NPI | 1720337579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60754230) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60185704) |
| 1041C0700X Social Worker, Clinical (Licence: WA SC60549720) | |
| 101YM0800X Counselor, Mental Health (Licence: WA CG60185704) | |
| Enumeration Date | 2012-09-06 |
| Last Update Date | 2025-12-29 |