| NPI | 1841891389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR 2904) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA 61183595) |
| Enumeration Date | 2020-11-02 |
| Last Update Date | 2025-03-28 |