| NPI | 1336261825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW00009362) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID 475) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2013-06-06 |