| NPI | 1275074759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NV 9082-C) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NV 7227-S) |
| Enumeration Date | 2017-03-16 |
| Last Update Date | 2022-03-18 |