| NPI | 1497222608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801114133) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WA SC60893202) |
| 1041C0700X Social Worker, Clinical (Licence: WA LW61139524) | |
| Enumeration Date | 2018-10-25 |
| Last Update Date | 2023-04-08 |