| NPI | 1740034792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA 61584639) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WA 61309633) |
| Enumeration Date | 2024-04-16 |
| Last Update Date | 2025-04-09 |