| NPI | 1013130558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60216256) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-41601) |
| 1041C0700X Social Worker, Clinical (Licence: OR L12238) | |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2024-12-13 |