| NPI | 1336944743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 260137) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IN 34011708A) |
| Enumeration Date | 2025-02-18 |
| Last Update Date | 2025-03-11 |