| NPI | 1447765011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09924681) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA LW60336220) |
| Enumeration Date | 2017-12-05 |
| Last Update Date | 2017-12-05 |