| NPI | 1033542139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: KS 4667) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KS 8924) |
| Enumeration Date | 2013-08-13 |
| Last Update Date | 2022-07-21 |