| NPI | 1487317087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC P020448) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P010218) |
| Enumeration Date | 2021-10-20 |
| Last Update Date | 2024-07-15 |