| NPI | 1104339951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS 4062) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2017039125) |
| Enumeration Date | 2017-11-14 |
| Last Update Date | 2023-11-30 |