| NPI | 1689142424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61524747) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2018-11-09 |
| Last Update Date | 2025-07-28 |