| NPI | 1184385015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: AK 214302) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CO 09931242) |
| 1041C0700X Social Worker Clinical (Licence: UT 14236886-3501) | |
| Enumeration Date | 2022-01-03 |
| Last Update Date | 2025-08-05 |