| NPI | 1992391254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WA LW61337945) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WA CG61248749) |
| 104100000X Social Worker (Licence: MT BBH-SWLC-LIC-43230) | |
| 104100000X Social Worker (Licence: WA SC61246297) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA SC61246297) | |
| Enumeration Date | 2020-12-21 |
| Last Update Date | 2024-10-10 |