| NPI | 1194564104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 0.09930420) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C019708) |
| 1041C0700X Social Worker, Clinical (Licence: ME LC23542) | |
| Enumeration Date | 2024-05-20 |
| Last Update Date | 2026-05-07 |