| NPI | 1912353236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AL 4086C) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA LW61263209) |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2022-11-29 |