| NPI | 1184307654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: TN LSW0000014688) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TN 14688) |
| Enumeration Date | 2023-08-10 |
| Last Update Date | 2025-11-06 |