| NPI | 1881162162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61024306) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60156882) |
| Enumeration Date | 2018-11-05 |
| Last Update Date | 2022-11-21 |