| NPI | 1053837443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS 10341) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 08092017273360) |
| Enumeration Date | 2017-08-17 |
| Last Update Date | 2023-06-24 |