| NPI | 1033857586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61397559) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA SC60882386) |
| Enumeration Date | 2022-05-24 |
| Last Update Date | 2023-04-12 |