| NPI | 1770001208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61544447) |
| Additional Taxonomies | 101Y00000X Counselor |
| 1041C0700X Social Worker, Clinical (Licence: WA 61222350) | |
| Enumeration Date | 2017-09-05 |
| Last Update Date | 2024-09-10 |