| NPI | 1023435807 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC200001949)  | 
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2011009028)  | 
| Enumeration Date | 2014-03-18 | 
| Last Update Date | 2025-08-13 |