| NPI | 1093526337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: DC LG200003205) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2025-01-16 |
| Last Update Date | 2025-01-30 |