| 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 |