| NPI | 1366715476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60681605) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C008570) |
| Enumeration Date | 2012-02-21 |
| Last Update Date | 2017-01-10 |