| NPI | 1730602970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101Y00000X Counselor (Licence: WA SC61454368) | |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2025-04-03 |