| NPI | 1568895795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AR 6894-C) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OK 5587) |
| Enumeration Date | 2013-08-12 |
| Last Update Date | 2026-02-04 |