| NPI | 1932204229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW00008701) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA RC00041808) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2024-05-03 |