| NPI | 1578332383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA SC61492166) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO LSW.0009924699) |
| Enumeration Date | 2023-12-21 |
| Last Update Date | 2023-12-21 |