| NPI | 1417328998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61131905) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2015-10-09 |
| Last Update Date | 2023-03-22 |