| NPI | 1457942955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WA LW61500348) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: ID 44303) |
| Enumeration Date | 2021-01-28 |
| Last Update Date | 2024-02-19 |