| NPI | 1043025240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA SC61690668) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL ISW21630) |
| Enumeration Date | 2025-02-12 |
| Last Update Date | 2025-06-18 |