| NPI | 1043496623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C006809) |
| Additional Taxonomies | 104100000X Social Worker (Licence: SC 8945) |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2025-01-29 |