| NPI | 1376530584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR 2650) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA LW 60041917) |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2012-05-31 |