| NPI | 1124512066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C013400) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NC P012219) |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2022-09-29 |