| NPI | 1649879222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61436624) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 9587939-35014) |
| Enumeration Date | 2020-10-23 |
| Last Update Date | 2023-06-26 |