| NPI | 1265163117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA SC61526673) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2022-06-21 |
| Last Update Date | 2024-03-12 |