| NPI | 1801535943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 11266039-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA SX61333841) |
| Enumeration Date | 2022-05-27 |
| Last Update Date | 2024-05-09 |