| NPI | 1225740160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: WV BP00945822) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WV BP00945822) |
| Enumeration Date | 2022-12-22 |
| Last Update Date | 2025-03-29 |