| NPI | 1871668442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60596082) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 36-123) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2019-10-14 |