| NPI | 1134340979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 4210) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR L2833) |
| 1041C0700X Social Worker, Clinical (Licence: WA LW00007242) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2007-07-08 |