| NPI | 1558870832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60821834) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA SC60503902) |
| Enumeration Date | 2017-09-29 |
| Last Update Date | 2023-02-02 |