| NPI | 1770541138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: OR L3666) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WA LW00008136) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2021-12-28 |