| NPI | 1770579773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA LW00006789) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA LW00006789) |
| Enumeration Date | 2005-09-25 |
| Last Update Date | 2007-07-08 |