| NPI | 1568194678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2022-06-28 |
| Last Update Date | 2026-06-30 |