| NPI | 1316485998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: WA LW60043463) |
| Enumeration Date | 2017-02-03 |
| Last Update Date | 2022-02-17 |