| NPI | 1689910655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WA LW60268189) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: WA SC60137259) |
| Enumeration Date | 2012-12-20 |
| Last Update Date | 2023-02-07 |