| NPI | 1992955165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW 60038643) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2004022498) |
| Enumeration Date | 2008-09-24 |
| Last Update Date | 2021-04-12 |