| NPI | 1255948196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC PO147001) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P1047001) |
| Enumeration Date | 2020-09-24 |
| Last Update Date | 2024-03-30 |