| NPI | 1790093227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW00004349) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 263462-3501) |
| Enumeration Date | 2010-09-17 |
| Last Update Date | 2012-03-08 |