| NPI | 1174106660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC200002388) |
| Additional Taxonomies | 104100000X Social Worker (Licence: DC LG50083307) |
| Enumeration Date | 2021-05-03 |
| Last Update Date | 2025-08-08 |