| NPI | 1013484781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA 60773522) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA 60773522) |
| Enumeration Date | 2018-10-30 |
| Last Update Date | 2018-10-30 |