| NPI | 1952021610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WA SC61325278) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| Enumeration Date | 2022-09-01 |
| Last Update Date | 2024-01-08 |