| NPI | 1255881975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC C012860) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NM C-10616) |
| Enumeration Date | 2016-10-05 |
| Last Update Date | 2023-06-05 |