| NPI | 1851940514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: ID LCSW37245) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: WA LW60432303) |
| Enumeration Date | 2019-09-05 |
| Last Update Date | 2023-07-27 |