| NPI | 1417683764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TN 8848) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904014181) |
| Enumeration Date | 2022-07-28 |
| Last Update Date | 2024-10-21 |