| NPI | 1346485372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60242907) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WA RC60026601) |
| 1041C0700X Social Worker, Clinical (Licence: WA 60242907) | |
| Enumeration Date | 2008-12-04 |
| Last Update Date | 2021-12-05 |