| NPI | 1801930490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WA LW608886741) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60145924) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2022-10-05 |