| NPI | 1396009130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60862145) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MT 2309) |
| Enumeration Date | 2012-06-26 |
| Last Update Date | 2018-09-13 |