| NPI | 1922464197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60810774) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WA SC60481300) |
| Enumeration Date | 2016-01-04 |
| Last Update Date | 2018-02-23 |