| NPI | 1073088779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID 5761478) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WA LW61310284) |
| Enumeration Date | 2018-10-09 |
| Last Update Date | 2025-03-19 |