| NPI | 1114120144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60068846) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 1030657) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2009-10-05 |