| NPI | 1548466154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS LSCSW 0545) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KS 0545) |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2025-04-09 |