| NPI | 1952774069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60644168) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA SC60329079) |
| Enumeration Date | 2015-11-11 |
| Last Update Date | 2016-06-29 |