| NPI | 1831715176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: OR L3548) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WA LW00007813) |
| 1041C0700X Social Worker Clinical | |
| Enumeration Date | 2020-06-23 |
| Last Update Date | 2020-06-23 |