| NPI | 1306857289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WA 60256464) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2022-07-21 |