| NPI | 1659487726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA lw00005915) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR or2559) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2022-11-13 |