| NPI | 1700439320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61089425) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID 39449) |
| Enumeration Date | 2019-07-23 |
| Last Update Date | 2025-01-06 |