NPI | 1962678367 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA 60365984) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL 3796) |
Enumeration Date | 2008-05-06 |
Last Update Date | 2013-07-04 |