| NPI | 1124561865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60966243) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: WA LW60966243) |
| Enumeration Date | 2016-11-29 |
| Last Update Date | 2020-06-26 |