| NPI | 1902562044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA SC70005630) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2021-11-12 |
| Last Update Date | 2025-10-09 |