| NPI | 1174578397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60655972) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: HI 3219) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2024-10-10 |