| NPI | 1184969917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA SC60384894) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WA SC60384894) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA CO60384987) | |
| Enumeration Date | 2012-12-05 |
| Last Update Date | 2013-07-25 |