| NPI | 1417349176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61196656) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WA LW61196656) |
| 1041C0700X Social Worker, Clinical (Licence: MI 6802088156) | |
| Enumeration Date | 2015-03-04 |
| Last Update Date | 2026-03-13 |