| NPI | 1336766740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC200004060) |
| Additional Taxonomies | 104100000X Social Worker (Licence: DC LG500883130) |
| Enumeration Date | 2020-07-01 |
| Last Update Date | 2025-11-19 |