| NPI | 1477924165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 87942) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA SC60600247) |
| 104100000X Social Worker (Licence: WA SC 60600247) | |
| 1041C0700X Social Worker, Clinical (Licence: UT 13368857-3501) | |
| Enumeration Date | 2015-10-07 |
| Last Update Date | 2023-06-05 |