| NPI | 1841769437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA SC60506415) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR L15060) |
| 1041C0700X Social Worker, Clinical (Licence: WA SC60506415) | |
| Enumeration Date | 2018-11-13 |
| Last Update Date | 2024-06-20 |