| NPI | 1750751756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60654067) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC200001688) |
| Enumeration Date | 2015-10-02 |
| Last Update Date | 2022-02-23 |