| NPI | 1609238146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60784137) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW017743) |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2020-04-11 |