| NPI | 1386289361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC C016205) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CA 86069) |
| Enumeration Date | 2019-11-13 |
| Last Update Date | 2024-03-04 |