| NPI | 1568976215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA SC60907423) |
| Additional Taxonomies | 101Y00000X Counselor |
| 104100000X Social Worker (Licence: RI CSW02127) | |
| Enumeration Date | 2017-11-16 |
| Last Update Date | 2018-10-30 |