| 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 |