| NPI | 1780550723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA SC61431886) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA SC61431886) |
| Enumeration Date | 2025-10-16 |
| Last Update Date | 2025-11-18 |