| NPI | 1235308727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61010549) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 18720) |
| Enumeration Date | 2008-02-28 |
| Last Update Date | 2022-11-15 |