| NPI | 1417327628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61058499) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA SC 60575262) |
| Enumeration Date | 2015-09-30 |
| Last Update Date | 2023-07-28 |