| NPI | 1124973458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA SC70016421) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA 16421) |
| Enumeration Date | 2026-03-02 |
| Last Update Date | 2026-03-20 |