| NPI | 1932331543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA SC61678823) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-29607) |
| Enumeration Date | 2009-08-14 |
| Last Update Date | 2025-05-28 |