| NPI | 1043037666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: SC 18034) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA SC61557709) |
| Enumeration Date | 2024-09-24 |
| Last Update Date | 2025-07-25 |