| NPI | 1073201935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 12468-123) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 35505) |
| 104100000X Social Worker (Licence: WI 131470-121) | |
| Enumeration Date | 2023-04-28 |
| Last Update Date | 2025-10-22 |