| NPI | 1952881161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61665696) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA SC61352470) |
| 175T00000X Peer Specialist (Licence: WA CG6084461) | |
| Enumeration Date | 2018-08-16 |
| Last Update Date | 2025-06-06 |