| NPI | 1760955256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA SC60917861) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA SC60917861) |
| Enumeration Date | 2019-01-07 |
| Last Update Date | 2024-07-31 |