| NPI | 1205927795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 120298-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA LW00006172) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2022-07-21 |