| NPI | 1952564601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WA LW60275447) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA SC60151055) |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2024-05-14 |