| NPI | 1124559232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MS C11412) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MS 906622) |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2025-01-24 |