| NPI | 1023148236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW00009168) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR 3832) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2011-01-12 |