| NPI | 1205575248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: AL 5284C) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: LA 4201) |
| Enumeration Date | 2022-05-28 |
| Last Update Date | 2023-07-21 |