| NPI | 1376824649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WA LW60761384) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CA LCS28457) |
| Enumeration Date | 2011-08-31 |
| Last Update Date | 2019-03-26 |