| NPI | 1801662754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA SC61501042) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WA SC61501042) |
| Enumeration Date | 2023-12-01 |
| Last Update Date | 2025-05-29 |