| NPI | 1932561115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW 35356) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA LW61085980) |
| Enumeration Date | 2016-03-25 |
| Last Update Date | 2021-10-14 |