| NPI | 1164504742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA LW00009736) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCS17846) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2014-03-27 |