| NPI | 1386798833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L11651) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA LW61669960) |
| 1041C0700X Social Worker, Clinical (Licence: TX 115168) | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2025-10-15 |