| NPI | 1659853158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA SC61410770) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 85360) |
| Enumeration Date | 2018-08-30 |
| Last Update Date | 2023-06-13 |