| NPI | 1730285131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L3476) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 1041C0700X Social Worker, Clinical (Licence: WA LW00007768) | |
| 1041C0700X Social Worker, Clinical (Licence: CA LCS 13627) | |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2009-09-24 |