| NPI | 1487736757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW00006070) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR OR#2244) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2012-01-03 |