| NPI | 1811282247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW00004709) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2019-05-18 |