| NPI | 1568821973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: HI 3920) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA LW61618529) |
| Enumeration Date | 2016-02-12 |
| Last Update Date | 2025-05-19 |