| NPI | 1144695552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60958095) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: SC SW.11458 LMSW) |
| Enumeration Date | 2015-12-10 |
| Last Update Date | 2020-11-17 |