| NPI | 1225440084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60724643) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW022225) |
| Enumeration Date | 2014-05-28 |
| Last Update Date | 2022-08-16 |