| NPI | 1922662030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61636644) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WA SC61412850) |
| Enumeration Date | 2019-04-24 |
| Last Update Date | 2025-04-15 |