| NPI | 1538644901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WA LW61311672) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| Enumeration Date | 2018-10-01 |
| Last Update Date | 2022-11-22 |