| NPI | 1023857513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA SC61517853) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA 61517853) |
| Enumeration Date | 2024-05-23 |
| Last Update Date | 2025-08-18 |