| NPI | 1245665116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MT 4439) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA LW70006559) |
| Enumeration Date | 2013-09-10 |
| Last Update Date | 2025-12-08 |