| NPI | 1497891162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L3286) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA LW00007678) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2014-11-14 |