| NPI | 1891326971 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 104100000X Social Worker (Licence: WA SC61483067) | 
| Additional Taxonomies | 1041C0700X Social Worker, Clinical | 
| Enumeration Date | 2020-01-28 | 
| Last Update Date | 2025-08-18 |