| NPI | 1083224059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC P022744) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NC 10220) |
| Enumeration Date | 2020-08-05 |
| Last Update Date | 2025-08-05 |