| NPI | 1073902821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60461631) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 1999140925) |
| Enumeration Date | 2015-01-16 |
| Last Update Date | 2015-01-16 |