| NPI | 1063962397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61253568) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WA SC60914302) |
| Enumeration Date | 2016-10-11 |
| Last Update Date | 2025-04-07 |