| NPI | 1255637377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60080832) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LC9324) |
| Enumeration Date | 2011-02-07 |
| Last Update Date | 2011-02-07 |