| NPI | 1710197645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L6074) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA LW60113465) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2015-01-26 |