| NPI | 1780035063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WA LW61004099) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WA SC 60491269) |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2022-08-19 |