| NPI | 1508163734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA 60741617) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR 3622) |
| 1041C0700X Social Worker, Clinical (Licence: CO CSW09923310) | |
| Enumeration Date | 2011-02-24 |
| Last Update Date | 2020-12-30 |