| NPI | 1356686398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L5904) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA LW60567700) |
| 1041C0700X Social Worker, Clinical (Licence: CA 28753) | |
| Enumeration Date | 2012-12-03 |
| Last Update Date | 2023-09-25 |