| NPI | 1063047991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PR 14320) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CO LSW.0009922283) |
| Enumeration Date | 2020-03-11 |
| Last Update Date | 2023-01-26 |