| NPI | 1831607787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA SC60968802) |
| Additional Taxonomies | 104100000X Social Worker (Licence: UT 10382599-3502) |
| Enumeration Date | 2018-01-12 |
| Last Update Date | 2019-07-01 |