| NPI | 1871974352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61081020) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health (Licence: WA CG60555513) | |
| Enumeration Date | 2015-06-10 |
| Last Update Date | 2022-07-21 |