| NPI | 1669947024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MO 2024035152) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: WA SC60909359) |
| Enumeration Date | 2018-10-11 |
| Last Update Date | 2025-05-19 |