| NPI | 1942085584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA SC61667760) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2023-08-30 |
| Last Update Date | 2025-10-28 |