| NPI | 1407511520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS 06100) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KS 11421) |
| Enumeration Date | 2021-11-03 |
| Last Update Date | 2023-07-14 |