| NPI | 1841027448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 0009926802) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA 61660530) |
| Enumeration Date | 2024-09-17 |
| Last Update Date | 2025-09-26 |