| NPI | 1033692637 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 1041C0700X Social Worker, Clinical | 
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: FL SW17668) | 
| 104100000X Social Worker | |
| Enumeration Date | 2018-09-10 | 
| Last Update Date | 2022-05-09 |