| NPI | 1790598142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA SC70038849) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG61658174) |
| Enumeration Date | 2025-01-29 |
| Last Update Date | 2025-10-06 |