| NPI | 1376102350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-39749) |
| Additional Taxonomies | 104100000X Social Worker (Licence: UT 103751433502) |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2025-09-14 |