| NPI | 1407241219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61102428) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: SC 12132) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2022-10-31 |