| NPI | 1811304553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61431521) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA CG60510613) |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2024-01-18 |