| NPI | 1881004711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61207023) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR L6970) |
| Enumeration Date | 2014-04-30 |
| Last Update Date | 2026-05-28 |