| NPI | 1740689504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60487839) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WA cg60131261) |
| Enumeration Date | 2014-08-18 |
| Last Update Date | 2022-07-18 |