| NPI | 1184481731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AL 2337C) |
| Additional Taxonomies | 374K00000X Religious Nonmedical Practitioner |
| Enumeration Date | 2024-02-29 |
| Last Update Date | 2024-02-29 |