| NPI | 1750850020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WA LW00009151) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: OR L4218) |
| Enumeration Date | 2018-11-16 |
| Last Update Date | 2021-11-12 |