| NPI | 1972004646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA LW61395239) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: WA LW61395239) |
| 104100000X Social Worker (Licence: OR A4865) | |
| Enumeration Date | 2018-02-27 |
| Last Update Date | 2023-10-31 |