| NPI | 1114396025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60449723) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR L6510) |
| Enumeration Date | 2015-09-21 |
| Last Update Date | 2015-09-21 |