| NPI | 1629132873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW00005613) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR L2959) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2007-07-09 |