| NPI | 1235540444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW00006525) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR 2022) |
| Enumeration Date | 2014-05-12 |
| Last Update Date | 2014-05-12 |