| NPI | 1922665926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CG60614693) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA CG60614693) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA CG60614693) | |
| Enumeration Date | 2019-05-24 |
| Last Update Date | 2022-01-27 |