| NPI | 1073092466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 011605) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2018-08-07 |
| Last Update Date | 2025-08-13 |