| NPI | 1982817615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L6264) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA LW60070767) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2025-05-21 |