| NPI | 1386869881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60202149) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2022-05-12 |