| NPI | 1609993344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WA LW60117760) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: WA RC00042021) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2015-06-14 |