| NPI | 1932636628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 10462) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA LW61608440) |
| 1041C0700X Social Worker, Clinical (Licence: MS C-11728) | |
| Enumeration Date | 2017-05-12 |
| Last Update Date | 2025-11-11 |