| NPI | 1003245242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L8221) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA LW60993977) |
| 1041S0200X Social Worker, School (Licence: OR 431736) | |
| Enumeration Date | 2013-11-07 |
| Last Update Date | 2022-04-26 |