| NPI | 1306879002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW00009590) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA RC00044680) |
| 104100000X Social Worker | |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2007-11-08 |