| NPI | 1245913359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2026019386) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MO 2023031829) |
| 1041C0700X Social Worker, Clinical (Licence: KS 14492) | |
| Enumeration Date | 2023-08-08 |
| Last Update Date | 2026-05-06 |