| NPI | 1215602313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 013559) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 5027) |
| Enumeration Date | 2021-08-11 |
| Last Update Date | 2025-04-11 |