| NPI | 1962232157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA SC61582410) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL ISW9538) |
| Enumeration Date | 2024-08-03 |
| Last Update Date | 2024-09-06 |