| NPI | 1508911959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 8795) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA RC00056209) |
| 104100000X Social Worker (Licence: WA LW60167698) | |
| 104100000X Social Worker (Licence: WI 8795) | |
| 1041C0700X Social Worker, Clinical (Licence: WA LW60167698) | |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2017-11-15 |