| NPI | 1861679599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA RC00056815) |
| Enumeration Date | 2008-01-24 |
| Last Update Date | 2021-06-22 |