| NPI | 1780001339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA LW60913237) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA ASW61417) |
| Enumeration Date | 2014-03-20 |
| Last Update Date | 2023-07-27 |