| NPI | 1215216486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS 06258) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KS 8121) |
| Enumeration Date | 2011-08-05 |
| Last Update Date | 2025-02-03 |