| NPI | 1760883516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61333020) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW1063) |
| Enumeration Date | 2014-09-11 |
| Last Update Date | 2022-11-09 |