| NPI | 1740836931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA SWI.LW.61644597) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA SWI.LW.61644597) |
| Enumeration Date | 2019-08-13 |
| Last Update Date | 2025-10-31 |