| NPI | 1710220991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09929522) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA LW61560900) |
| Enumeration Date | 2013-04-05 |
| Last Update Date | 2024-08-22 |