| NPI | 1063988327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61508432) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW24067) |
| Enumeration Date | 2018-10-15 |
| Last Update Date | 2026-07-22 |