| NPI | 1518017904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA LW00004500) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA LW00004500) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2014-02-10 |