| NPI | 1184293235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: PR 15203) |
| Additional Taxonomies | 1041S0200X Social Worker School (Licence: PR 15203) |
| Enumeration Date | 2021-06-23 |
| Last Update Date | 2023-03-21 |