| NPI | 1457086688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 132697-121) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 11798-123) |
| Enumeration Date | 2022-07-21 |
| Last Update Date | 2024-08-23 |