| NPI | 1992985147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WA LW60190454) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor Mental Health | |
| 104100000X Social Worker | |
| 1041C0700X Social Worker Clinical | |
| Enumeration Date | 2007-11-05 |
| Last Update Date | 2025-07-07 |