| NPI | 1184808701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60717124) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA LW60717124) |
| 104100000X Social Worker (Licence: WA LW60717124) | |
| Enumeration Date | 2007-12-18 |
| Last Update Date | 2018-08-08 |