| NPI | 1043660343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW28575) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA LW00009000) |
| Enumeration Date | 2016-06-16 |
| Last Update Date | 2016-08-31 |