| NPI | 1598248924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA SC61516213) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TN 11229) |
| Enumeration Date | 2018-09-11 |
| Last Update Date | 2024-08-09 |