| NPI | 1972785749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60820118) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2007-12-03 |
| Last Update Date | 2023-05-10 |