| NPI | 1376271494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C018425) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 31265) |
| Enumeration Date | 2022-08-09 |
| Last Update Date | 2025-11-20 |