| NPI | 1720253677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60569315) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2019-12-02 |