| NPI | 1023378163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60682632) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C007751) |
| Enumeration Date | 2012-05-23 |
| Last Update Date | 2023-12-13 |