| NPI | 1417118068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61638940) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR L7605) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2025-09-18 |