| NPI | 1356586663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L3916) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA LW00009101) |
| 1041C0700X Social Worker, Clinical (Licence: AK 756) | |
| Enumeration Date | 2008-12-16 |
| Last Update Date | 2008-12-16 |