| NPI | 1831802297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA SC61659288) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA CG61389317) |
| Enumeration Date | 2023-01-02 |
| Last Update Date | 2025-07-30 |