| NPI | 1083839773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH00006524) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2019-01-11 |