| NPI | 1306490024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: TN 8013) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TN 11891) |
| Enumeration Date | 2019-07-31 |
| Last Update Date | 2022-01-24 |