| NPI | 1659840627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 25592) |
| 1041C0700X Social Worker, Clinical (Licence: WA LW60984904) | |
| Enumeration Date | 2018-11-19 |
| Last Update Date | 2020-04-01 |