| NPI | 1437744893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 24337) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA LW61426779) |
| Enumeration Date | 2021-03-07 |
| Last Update Date | 2023-09-27 |