| NPI | 1104640697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NV 11884-M) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NV IC-2575) |
| Enumeration Date | 2024-11-11 |
| Last Update Date | 2024-11-19 |