| NPI | 1467196444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61575143) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WA SA61268205) |
| 1041C0700X Social Worker, Clinical (Licence: SC 15313) | |
| Enumeration Date | 2022-04-25 |
| Last Update Date | 2024-10-01 |