| NPI | 1982976239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH60254611) |
| 101YM0800X Counselor, Mental Health (Licence: UT 11565143-6004) | |
| Enumeration Date | 2012-02-02 |
| Last Update Date | 2026-08-04 |