| NPI | 1619970241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW 00004324) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA LW00004324) |
| 174400000X Specialist (Licence: WA LH00004581) | |
| 174400000X Specialist (Licence: WA LF00001420) | |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2009-06-18 |