| NPI | 1336257492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: OR 2222) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: WA 9475) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2022-03-09 |