| NPI | 1881828051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61504049) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID LMSW 25-909) |
| Enumeration Date | 2009-05-04 |
| Last Update Date | 2026-03-13 |