| NPI | 1750932562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA SC61139467) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 101Y00000X Counselor | |
| Enumeration Date | 2019-09-23 |
| Last Update Date | 2022-07-25 |