| NPI | 1447010046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: PR 11945) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PR 11945) |
| 1041S0200X Social Worker School | |
| Enumeration Date | 2024-03-20 |
| Last Update Date | 2024-03-20 |