| NPI | 1285965327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WA LW61220881) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CA 28379) |
| Enumeration Date | 2010-01-28 |
| Last Update Date | 2024-01-12 |