| NPI | 1578922886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60980523) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA 60694985) |
| Enumeration Date | 2016-02-15 |
| Last Update Date | 2021-04-19 |