| NPI | 1942612494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA LW60626693) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6801094378) |
| 101YM0800X Counselor, Mental Health | |
| 1041C0700X Social Worker, Clinical (Licence: WA LW60626693) | |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2022-01-28 |