| NPI | 1487179958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: IA 077789) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IA 077789) |
| Enumeration Date | 2017-08-07 |
| Last Update Date | 2023-09-05 |