| NPI | 1124804331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L11712) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OR A12865) |
| Enumeration Date | 2023-09-04 |
| Last Update Date | 2024-10-04 |