| NPI | 1912541566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA 60790068) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA SC60790068) |
| Enumeration Date | 2019-11-06 |
| Last Update Date | 2022-10-28 |