| NPI | 1669940698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61049298) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WA LW61049298) |
| 1041C0700X Social Worker, Clinical (Licence: WA SC60665700) | |
| Enumeration Date | 2018-11-07 |
| Last Update Date | 2023-10-24 |