NPI | 1861985418 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61533180) |
Additional Taxonomies | 101Y00000X Counselor (Licence: WA SC61172478) |
Enumeration Date | 2018-06-08 |
Last Update Date | 2024-07-24 |