| NPI | 1447647037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60390407) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 15008) |
| Enumeration Date | 2015-04-21 |
| Last Update Date | 2015-04-21 |