| NPI | 1124502554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TN 8494) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TN 11678) |
| Enumeration Date | 2018-09-21 |
| Last Update Date | 2023-09-06 |