| NPI | 1326193780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA LW0006203) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WA LW00006203) |
| 1041C0700X Social Worker Clinical (Licence: WA LW0006203) | |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2007-07-08 |