| NPI | 1821431362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA 020704 LW00007092) |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: WA 4014655) |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2013-04-15 |