| NPI | 1851625842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60212296) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA RC 00034271) |
| Enumeration Date | 2009-09-24 |
| Last Update Date | 2024-08-21 |