| NPI | 1952039604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60100000) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC61336262) |
| Enumeration Date | 2022-08-10 |
| Last Update Date | 2023-11-14 |