| NPI | 1821462573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61590570) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MA 60580757) |
| Enumeration Date | 2015-11-18 |
| Last Update Date | 2025-01-14 |