| NPI | 1104121771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WA LW60535147) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WA LW60535147) |
| Enumeration Date | 2011-01-12 |
| Last Update Date | 2022-10-05 |