| NPI | 1336958404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA SC61645919) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: WA SC61645919) |
| Enumeration Date | 2025-01-03 |
| Last Update Date | 2025-08-08 |