| NPI | 1477272268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2025053709) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KS 07115) |
| Enumeration Date | 2022-08-24 |
| Last Update Date | 2026-03-24 |