| NPI | 1912421348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60306852) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR L18069) |
| Enumeration Date | 2017-07-27 |
| Last Update Date | 2026-06-05 |