| NPI | 1548671993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NV 1001-C) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MO 2014013386) |
| Enumeration Date | 2014-05-19 |
| Last Update Date | 2024-08-07 |