| NPI | 1366826216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA SC60625247) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 081330) |
| Enumeration Date | 2015-07-09 |
| Last Update Date | 2016-03-07 |