| NPI | 1184284861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2025000496) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KS 06656) |
| Enumeration Date | 2019-06-16 |
| Last Update Date | 2025-01-16 |