| NPI | 1518723907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: AL 5946G) |
| Additional Taxonomies | 104100000X Social Worker (Licence: LA 16768) |
| Enumeration Date | 2024-02-23 |
| Last Update Date | 2024-02-23 |